Injured Child

Question 1

What injuries do children sustain?

Answer 1

Fractures
Wounds
Burns and scalds
Head injury
Drowning

Question 2

What are some confounding variables that affect injury in children?

Answer 2

Cold
Alcohol
Drugs
Hypoglycaemia

Question 3

What are some common types of fracture in children?

Answer 3

Greenstick
Buckle fracture of distal radius
Clavicle
Toddlers fracture of Tibia

Question 4

How does a child’s size affect their susceptibility to injury?

Answer 4

Smaller target than adults so more energy is absorbed for the same force of impact.
Large surface area to volume ratio - heat loss is significant in small children.
Large head
Drug doses and fluid requirements differ along with equipment.

Question 5

What about a child skeleton makes it more susceptible to injury?

Answer 5

Incompletely calcified - soft, springy, deforms rather than breaks, poor at absorbing energy.
Provides less protection for vital organs.

Question 6

What about a child’s insides that make it more susceptible to injury?

Answer 6

Less elastic connective tissue - shearing and de-gloving.

Crowding of poorly protected vital organs.

Question 7

What about a child’s metabolism makes it more susceptible to injury?

Answer 7

Thermoregulation - little brown fat and immature shivering.
Poikilothermic - internal temp varies.
Environmental considerations.
Hypoglycaemia - little glycogen stored in liver, exacerbated by hypothermia and vice versa. Develops quickly in sick children.

Question 8

What are some different injury patterns in children?

Answer 8

SCIWORA - spinal cord injury without radiological abnormality.

Lap belt syndrome

Question 9

What is the normal respiratory rate of a child?

Answer 9

<1 = 30-40
2-5 = 25-30
5-12 = 20-25
>12 = 15-20

Question 10

What is the normal systolic BP of a child?

Answer 10

<1 = 70-90
2-5 = 80-100
5-12 = 90-110
>12 = 100-120

Question 11

What is the normal heart rate of a child?

Answer 11

<1 = 110-160
2-5 = 95-140
5-12 = 80-120
>12 = 60-100

Question 12

What are some life threatening examples of trauma?

Answer 12

Respiratory failure:
Obstruction - croup, birth asphyxia, epiglottitis, foreign body inhalation, bronchiolitis, asthma, pneumothorax.
Depression - poisoning, convulsions, raised ICP (head injury).

Circulatory Failure:
Fluid loss - gastroenteritis, burns, trauma.
Fluid maldistribution - sepsis, anaphylaxis, heart failure.

Question 13

What is the aim of trauma resuscitation?

Answer 13

To restore normal tissue oxygenation as quickly as possible.

Question 14

What is the order of management that occurs within the ED?

Answer 14

cABCDE
Primary survey and resus
Secondary survey
Emergency treatment
Definitive care
Reassessment

Question 15

What does cABCDE stand for?

Answer 15

c = catastrophic haemorrhage control. 
A = airway and c spine - O2. 
B = breathing and ventilation
C = Cirulation with haemorrhage control
D = disability
E = exposure/environment

Don’t Ever Forget Glucose!

Question 16

What is the normal weight of a child?

Answer 16

Birth weight approx 3.5kg
<1 yr = (0.5 x age in months) + 4.
1-5yrs = (2 x age) + 8
6-10yrs = (3 x age) + 7